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ȣ - 510461 311 |
Impact of Diabetes Mellitus on Intravascular Ultrasound Findings in Patients with Acute Myocardial Infarction with Plaque Ruptures |
전남대학교병원 심장센터 심도자실, 전남대학교 심혈관계 특성화 사업단 |
최윤하, 홍영준, 정명호, 안영근, 윤남식, 윤현주, 문재연, 김계훈, 박형욱, 김주한, 조정관, 박종춘, 강정채 |
Background: Plaque rupture and subsequent thrombus formation is the most important mechanism leading to an acute myocardial infarction (AMI). Previous pathological study showed diabetic patients had a larger content of lipid-rich atheroma and macrophage infiltration compared with nondiabetic patients. This is consistent with a greater probability of coronary plaque rupture in diabetic patients. However, data on the intravascular ultrasound (IVUS) findings in diabetic patients with AMI with plaque rupture are lacking.
Objectives and Methods: The aim of this study was to assess the impact of diabetes mellitus on IVUS findings in 112 AMI patients (58 ST segment elevation and 54 non-ST segment elevation MI) with plaque ruptures. IVUS findings included ruptured plaque (a cavity that communicated with the lumen with an overlying residual fibrous cap fragment), multiple ruptured plaques (separated by a >5-mm length of artery containing smooth lumen contours), and a thrombus (discrete intraluminal filling defects).
Results: Baseline high-sensitivity C-reactive protein (4.6±4.6 mg/dl vs. 2.4±4.2 mg/dl, p=0.050) and triglyceride levels (158±84 mg/dl vs. 127±52 mg/dl, p=0.041) were significantly higher in diabetic patients compared with non-diabetic patients. Reference segment plaque burden was greater in diabetic patients compared with non-diabetic patients (37±10% vs. 31±12%, p=0.006). The presence of multiple plaque ruptures (60% vs. 29%, p=0.001) and thrombus (72% vs. 52%, p=0.032) were more common in diabetic patients compared with non-diabetic patients. Plaque cavity was significantly larger (2.6±1.6 mm2 vs. 2.2±1.2 mm2, p=0.046) and ruptured plaque length was significantly longer (3.0±1.6 mm vs. 2.5±1.3 mm, p=0.031) in diabetic patients compared with non-diabetic patients.
Conclusions: Diabetic AMI patients with IVUS-evident plaque ruptures have more plaque vulnerability (more frequent multiple plaque ruptures and thrombus) accompanied with higher inflammatory status compared with non-diabetic AMI patients with plaque ruptures.
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